Guidelines For Correction of Warfarin Over-Anticoagulation
Adapted from: Ansell J et al. Chest 2008; 133 (suppl 6):160-198
| INR | Clinical Setting | Therapeutic Options |
|---|---|---|
| <5 | No bleeding | Hold warfarin until INR in therapeutic range +/- vitamin K 2.5mg po |
| Rapid reversal required | Hold warfarin and give vitamin K 1mg IV infusion or 2.5mg po | |
| 5.0-8.9 | No bleeding | Hold warfarin until INR in therapeutic range +/- vitamin K 2.5mg po |
| Rapid reversal required | Hold warfarin and give vitamin K 1-2mg IV infusion or 2.5-5mg po | |
| >9 | No bleeding | Hold warfarin until INR in therapeutic range and give vitamin K 2.5-5mg po or 1-2mg IV and may repeat q24h as necessary |
| Rapid reversal required | Hold warfarin and give vitamin K 1-10mg IV and may repeat q6-24h as necessary | |
| Any INR | Serious or life-threatening bleeding | Hold warfarin and give vitamin K 10mg IV infusion and supplement with FFP or PCC (prothrombin complex concentrates) or recombinant VIIa and repeat as necessary guided by INR |